Arthroscopic knot tying device

ABSTRACT

A method for closing an incision (I) deep within a patient&#39;s body (B) with a suture (S). A medical instrument (C) has arms 1 and 2 for openings and closing opposed jaws (3,4). Each jaw has a pair of openings (3A-3B, 4A-4B). A knot (K) is formed using the ends (S1, S2) of the suture. For this purpose, the ends of the suture are withdrawn from the body. This allows the surgeon to form a proper surgical knot. After forming the knot, the suture ends are inserted through the respective pairs of openings. The surgeon can now draw the knot tightly down on the incision to close it by inserting the jaws end of the instrument into the patient&#39;s body while applying a slight pulling force on the ends of the suture. The surgical knot thus made will not thereafter loosen.

BACKGROUND OF THE INVENTION

This invention relates to arthroscopic and/or endoscopic surgery andmore particularly, to a method of performing a surgical procedure and asurgical appliance useful in performing the method.

In performing surgical procedures, one problem commonly encountered istying off stitches closing an incision in such a way as to prevent theknot from loosening or coming undone. If the surgery is performed in alocale where the patient's skin is, or can be drawn back, exposing thesurgical site, tying off stitches so they do not come undone should notbe a problem. In arthroscopic and/or endoscopic surgeries where thesurgical site is deep inside the body so the site is not readilyaccessible, this is not easily done. Because the surgical site isusually also very small, the surgeon is typically working in a veryconfined area and is probably using an endoscope in order to view thework he is performing. As a consequence, he does not have the space tomake the type of surgical knot he would like to make, or to make itsufficiently tight it will not later loosen. The knot he uses in thissituation is usually a slip knot, or some variation thereof, rather thana double knot which is preferred for closing incisions. If a knotbecomes undone in this latter instance, the surgical site must bereopened so the stitches can be tied off again. This is not acceptable.It would be preferable if the surgeon could prepare the knot ex situwhere there is adequate room for him to work, but current surgicalprocedures and instruments do not allow him to do so.

SUMMARY OF THE INVENTION

Among the several objects of the present invention may be noted toprovision of a surgical method of performing a surgical procedureespecially an arthroscopic and/or endoscopic surgical procedure; theprovision of such a method in which a length of suture used in closingan opening can be drawn from the surgical site to a location where thesurgeon has ample space to tie a surgical knot; the provision of such amethod which thereafter permits the surgeon to readily return theknotted portion of the suture back to the site and tighten it in placeso it does not thereafter slip or loosen; the provision of such a methodwhich allows the surgeon to securely and permanently tie off a suture soit does not thereafter have to be retied; the provision of a pair offorceps for use by the surgeon is performing the method, the forcepshaving a pair of jaws through which the suture can be inserted; theprovision of such forceps which allows the surgeon to draw the sutureaway from the surgical site (i.e., external to the body) where thesurgeon has ample room to prepare a preferred surgical knot and thentransfer the knot back to the site using forceps; and, the provision ofsuch a surgical appliance which is easy to use and can also be used as aconventional surgical instrument.

The method of the invention, briefly stated, comprises using a surgicalinstrument such as forceps at a surgical site, especially anarthroscopic and/or endoscopic surgical site which is not readilyaccessible. A suture for closing an opening at the site is to be knottedwith a surgical knot. The ends of the suture are withdrawn from the bodyand a knot is formed using the free ends of the suture. After the knotis formed, the ends of the suture adjacent the knot are drawn intorespective openings in the instrument. The knotted end of the suture isthen transferred back to the surgical site using the instrument so afirm knot is tied at the surgical site which will not subsequentlyloosen. Other objects and features will be in part apparent and in partpointed out hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1-2 illustrates a surgical instrument of the present invention;

Figs 3-7 illustrate the method of the present invention by which asurgeon can tie a proper surgical knot in a suture using the instrument;

FIGS. 8-10 illustrate alternate embodiments of the surgical instrumentuseful in performing the method.

Corresponding reference characters represent corresponding partsthroughout the drawings.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring to the drawings, a surgical site X is located within apatient's body B. During performance of surgery, for example, anarthroscopic surgery at site X, an incision I is made. A suture S issubsequently used by the surgeon to close the incision. Heretofore, ifsite X was remote within the patient's body, the surgeon's ability totie a satisfactory knot K in the suture has been severely limited. Thetype of knot preferred for tying off the suture is a double knot whichdoes not loosen over time. Because of the inaccessibility of site X, thesurgeon has previously only been able to use a slip knot or similar knotwhich may loosen over time. If this happens, there is a good chance theincision will not properly close and additional surgery may be required.

In accordance with the present invention, a surgical instrument C (seeFIGS. 1 and 2) has a pair of cooperating arms 1 and 2 with respectivejaws 3 and 4 at the end of the arms. Instrument C is an elongate, thininstrument for being readily positioned at a remote site inside thepatient's body. The jaws are located at the inner end of the instrument.The arms are hingedly connected at 5, this hinge point being at theopposite, external end of the instrument. Because of the limitedaccessibility of site X, a cannula L is inserted in an opening 01 in thepatient's skin N and the inner end of the cannula is positioned adjacentthe site. To help the surgeon see what he is doing, an endoscopic deviceD is inserted through a second opening 02 in the skin and alsopositioned adjacent the surgical site.

As shown in FIG. 3, once the surgeon has sewn up the incision usingsuture S, he draws the ends S1 and S2 of the suture out of the patient'sbody through the cannula. Next, the surgeon ties an appropriate knot Kwith the ends of the suture (see FIG. 4).

By manipulating arms 1 and 2 of instrument, the surgeon can open thejaws of the instrument, as seen in FIGS. 2 and 5. Each jaw has a pair ofopenings. Jaw 3 has openings 3A and 3B, and jaw 4 has openings 4A and4B. Once the surgeon has prepared knot K, he routes each end of thesuture into one of the openings of each respective pair, and out theother opening. Thus, as shown in the drawings, suture end S1 is insertedinto opening 4A from the outside of the jaw 4 into the jaw, and thendraws the end back out of the jaw through opening 4B. The same thing isdone with end S2. Once the suture ends are inserted through theinstrument jaws, the jaws are closed, and the suture ends are drawn backalong the shank of the instrument. The elongate, shank portion ofinstrument C is sized to fit through cannula L as shown in FIGS. 6 and7. To draw knot K down onto the incision, the surgeon exerts a constantpulling force on suture ends S1 and S2. As he does so, he inserts thejaws end of the instrument C through cannula L. The movement of theinstrument toward the incision site and the pressure on the ends of thesuture effectively moves knot K until it is tightly drawn up against theincision, closing it.

To tie a double knot, the surgeon releases the pressure on the ends ofthe suture and then withdraws the instrument back out of the cannula.The ends of the suture remain threaded through the openings in jaws 3and 4, but because there is no force on them, knot K does not move. Oncewithdrawn from the patient's body B, the surgeon re-opens jaws 3 and 4and pulls the ends of the sutures out of the jaws. He then repeats theabove steps, tying a new knot K with the ends of the suture, reinsertingthe suture ends through the openings in the jaws, closing the jaws, andreinsetting the jaw end of the instrument into the cannula to draw thissecond knot down onto the first. After the knot is completed, instrumentI is withdrawn as before. The ends S1, S2 of the suture can then be cut.

Referring to FIGS. 8-10, and alternate embodiment C' of the instrumentis shown in FIG. 8, and is similar to the instrument C previouslydescribed. Now, however, jaws 3' and 4' each have a notch, 6 and 7respectively at their outer, tip end. Now, instead of two holes in eachjaw, there is only one, 8 and 9 respectively. As seen, once knot K isformed, end S1 is routed through notch 6 in jaw 3' and opening 9 in jaw4'. End S2 is routed through notch 7 in jaw 4 and opening 8 in jaw 3'.Once this is done, the jaws are closed and the instrument is operated asbefore. Alternately, and as shown in Figs 2 and 10, hooks H or eyelets Ecan be formed on opposite sides of an instrument C". The free ends S1and S2 of the suture are captured by, or pass through the hooks oreyelets. It will be understood that the size of instrument C",regardless of whether it has hooks or eyelets, must be such as to passthrough cannula L so the knot can be drawn down on the incision.

In view of the foregoing, it will be seen that the several objects ofthe invention are achieved and other advantageous results are obtained.

As various changes could be made in the above constructions withoutdeparting from the scope of the invention, it is intended that allmatter contained in the above description or shown in the accompanyingdrawings shall be interpreted as illustrative and not in a limitingsense.

Having thus described the invention, what is claimed and desired to besecured by Letters Patent is:
 1. A method of performing a surgicalprocedure involving the closure of an incision deep within a patient'sbody with a suture comprising:threading the suture about the incision toeffect closure of the incision; withdrawing the ends of the suture fromthe patient's body; forming a know with the ends of the suture outsidethe patient's body; inserting the ends of the suture through respectiveopenings in a medical instrument having a pair of jaws with openingstherein for the ends of the suture, the ends of the suture being drawncompletely through the openings; inserting the portion of the instrumentwhere the openings are located into the body and moving it to theincision site, the jaws of the instrument being opened after the knot isformed to receive threads of the suture and closed prior to insertingthe instrument in the patient's body; applying a continuous pressure onthe suture ends as the instrument is inserted to thereby draw the knowdown into the incision; and, cutting off the ends of the suture afterthe knot is drawn down on the incision and closes it, the knot beingsufficiently tight so as not to thereafter loosen.
 2. The method ofclaim 1 further including repeating the above series of steps withsuccessive sutures whereby a series of knots are formed which extendfrom one end of the incision to the other to close the incision.
 3. Themethod of claim 1 further including:withdrawing the ends of the suturefrom the respective openings in the jaws of the medical instrument afterthe knot is drawn down on the incision; withdrawing the medicalinstrument and suture ends from the patient's body; repeating theaforementioned steps ofa) forming a knot with the ends of the suture, b)inserting the ends of the suture into openings in the pairs of theinstrument, c) inserting the instrument into the body, d) applying acontinuous pressure on the suture ends; thereby to draw a second knotdown onto the first knot, and then cutting off the ends of the suture.